Background: The global burden of cardiovascular disease (CVD) continues to
rise. Successful treatment of CVD requires adequate pharmaceutical management. The aim was to examine the
availability, pricing and affordability of cardiovascular medicines in developing countries using the standardized data
collected according to the World Health Organization/Health Action International methodology.

Methods: The following medicines were included: atenolol, captopril,
hydrochlorothiazide, losartan and nifedipine. Data from 36 countries were analyzed. Outcome measures were percentage
availability, price ratios to international reference prices and number of day's wages needed by the lowest-paid unskilled
government worker to purchase one month of chronic treatment. Patient prices were adjusted for inflation and
purchasing power, procurement prices only for inflation. Data were analyzed for both generic and originator brand products
and the public and private sector and summarized by World Bank Income Groups.

Results: For all measures, there was great variability across surveys. The
overall availability of cardiovascular medicines was poor (mean 26.3% in public sector, 57.3% private sector). Procurement prices
were very competitive in some countries, whereas others consistently paid high prices. Patient prices were
generally substantially higher than international references prices; some countries, however, performed well.
Chronic treatment with anti-hypertensive medication cost more than one day's wages in many cases. In particular when
monotherapy is insufficient, treatment became unaffordable.

Conclusions: The results of this study emphasize the need of focusing
attention and financing on making chronic disease medicines accessible, in particular in the public sector. Several policy
options are suggested to reach this goal.